Basic Information
| Provider Information | |||||||||
| NPI: | 1710934385 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GLADDEN | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8150 N CENTRAL EXPY | ||||||||
| Address2: | STE M1001 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752061815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2142210022 | ||||||||
| FaxNumber: | 2146918292 | ||||||||
| Practice Location | |||||||||
| Address1: | 8150 N CENTRAL EXPY | ||||||||
| Address2: | SUITE M1001 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752061815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2142210022 | ||||||||
| FaxNumber: | 2146918292 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | H4934 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 2316140 | 01 | TX | BLUELINK | OTHER | 060043414 | 01 | TX | RR MCARE | OTHER | 139652508 | 05 | TX | MEDICAID | 139652516 | 05 | TX | MEDICAID |